Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.Ģ. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred.ġ. Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.ī. first responders collecting human remains police officers repeatedly exposed to details of child abuse). Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.Ĥ. Learning that the traumatic event(s) occurred to a close family member or close friend. Witnessing, in person, the event(s) as it occurred to others.ģ. Directly experiencing the traumatic event(s).Ģ. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways.ġ. DSM-5 Criteria for Posttraumatic Stress Disorder a A. Coase warned, “If you torture the data long enough, it will confess.Table 1. Coincidentally (although as skeptics, we do not believe in coincidence), the initial statistical team was changed when data were sold to the French pharmaceutical company applying for the marketing authorization in France. Although he cited us,3 he overlooked the evidence we provided indicating that the Bacloville article4 was published without acknowledging major changes to the initial protocol, affecting the primary outcome. Second, Dr Andrade should have warned readers that Bacloville’s results are most questionable, lacking robustness. To the Editor: Dr Andrade’s analysis of the Bacloville trial in a recent Clinical and Practical Psychopharmacology column, in which he concluded that “individualized treatment with high-dose baclofen (30-300 mg/d) may be a useful second-line approach in heavy drinkers” and that “baclofen may be particularly useful in patients with liver disease,” deserves comment.1įirst, Andrade failed to recall that the first pivotal trial of baclofen, ALPADIR (NCT01738282 320 patients, as with Bacloville), was negative (see Braillon et al2). Although prediction is modest, it suggests that the new ASD diagnosis can serve a useful function in acute trauma settings for triaging those who can benefit from either early intervention or subsequent monitoring.īaclofen, a French Exception, Seriously Harms Alcohol Use Disorder Patients Without Benefit More than half of participants with DSM-5-defined ASD had a subsequent disorder.Ĭonclusions: The DSM-5 criteria for ASD results in better identification of people who will subsequently develop PTSD or another psychiatric disorder relative to the DSM-IV criteria. Sensitivity was improved for DSM-5 relative to DSM-IV for depression (0.18 vs 0.30), panic disorder (0.19 vs 0.41), agoraphobia (0.14 vs 0.40), social phobia (0.12 vs 0.44), specific phobia (0.24 vs 0.58), obsessive-compulsive disorder (0.17 vs 0.47), and generalized anxiety disorder (0.20 vs 0.47). Comparable proportions of those diagnosed with ASD developed PTSD using DSM-IV (3 months = 46%, 12 months = 39%, 24 months = 32%, and 72 months = 25%) and DSM-5 (43%, 42%, 33%, and 24%) ASD definitions. PTSD was diagnosed in 93 patients (9%) at 3, 82 patients (10%) at 12, 100 patients (12%) at 24, and 26 patients (8%) at 72 months 19 patients (6%) met DSM-5 criteria for PTSD at 72 months. Results: Forty-five patients (8%) met DSM-IV criteria, and 80 patients (14%) met DSM-5 criteria for ASD. The Mini-International Neuropsychiatric Interview (MINI) was used at each assessment to assess anxiety, mood, and substance use disorders. Method: Patients with randomized admissions to 5 hospitals across Australia (N = 596) were assessed in hospital and reassessed for PTSD at 3 (n = 508), 12 (n = 426), 24 (n = 439), and 72 (n = 314) months using the Clinician-Administered PTSD Scale DSM-IV definition of PTSD was used at each assessment, and DSM-5 definition was used at 72 months. Objective: This study addresses the extent to which DSM-IV and DSM-5 definitions of acute stress disorder (ASD) predict subsequent posttraumatic stress disorder (PTSD) and related psychiatric disorders following trauma.
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